Healthcare Provider Details

I. General information

NPI: 1568382877
Provider Name (Legal Business Name): AIME PUENTES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 BRAXSTYN WAY W
MADERA CA
93636-9174
US

IV. Provider business mailing address

1190 BRAXSTYN WAY W
MADERA CA
93636-9174
US

V. Phone/Fax

Practice location:
  • Phone: 559-871-7340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95190115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: